Tom Lever was a thoroughgoingly practical man, according to his wife of 40 years, Theresa. In the car on the way to an appointment with his oncologist, two and a half days before he died of lung cancer on March 1, 2018, Tom started talking to Theresa about tires. 

"'Make sure you always have good tires,'" Theresa recalled him telling her. "'I haven't been happy with the Cooper Weather-Masters.'"

While they were waiting in the oncologist's office, Theresa said, Tom seemed to have a sudden revelation.

"Oh, I know what happens next," he told her. "I know what happens next." 

"You do?" Theresa asked. "What is it?"

Tom gave her an inscrutable look. "I'm not telling you."

In his final days, Tom decided what would happen next, at least to his mortal chassis: He would donate his body to the University of Vermont's Robert Larner College of Medicine. Theresa had learned about UVM's Anatomical Gift Program during her 38-year career as a social worker at Central Vermont Medical Center, and she and Tom approached the subject of what to do with his body with equanimity. "We're both very practical people," she said. "And that just seemed like a practical thing to do."

The consent form included a space for donors to offer a few words to the medical students who would someday learn from their remains. Tom wrote: "Don't smoke. Don't drink. Take care of your teeth." And also, "Live long and prosper." 

Each year, an estimated 20,000 people in the U.S. bequeath their bodies to medical education and research programs. UVM, which has accepted body donations since 1909, typically receives between 30 and 50 donors a year, according to Gary Mawe, a neurological sciences professor and the director of the university's Anatomical Gift Program. At UVM and other institutions, the word "donor," rather than the slightly macabre-sounding "cadaver," is the preferred nomenclature: "There was an effort in the early 2000s, among people in anatomical education, to reflect the fact that this is a magnanimous gift that these people have given us," Mawe explained.

Out of respect for that magnanimity, UVM maintains strict ethical boundaries in its anatomy program. Students never learn the names of the donors, whose anatomical idiosyncrasies they come to understand better than their own, and the only people allowed to view the donors' bodies are anatomy students. Each spring, the medical school holds a ceremony, called the Convocation of Thanks, as a tribute to donors and their families. Even though the ceremony includes a PowerPoint presentation featuring photos and remembrances of the donors, UVM does not provide students with any information that would connect the people pictured in the slides, smiling with their grandkids or mugging for the camera with a French fry between their teeth, with the particular donors whose bodies they dissected in the lab.

"In some ways, you have to compartmentalize," Mawe said. "You have to be aware of the humanity of it so that you don't drop your guard and do anything disrespectful, and you have to focus on what you need to learn."

The first documented practice of using cadavers for medical education dates back to the third century BC, when the physicians of the ancient Greek city of Alexandria began dissecting human remains to better understand how disease and injury ravaged the inner architecture of the body. For the next millennium and a half, the rise of Christianity put a stop to anatomical research on cadavers throughout Europe — the Roman Catholic Church considered it blasphemous — until a more freethinking Holy Roman Emperor, Frederick II, decided there might be some value in reviving the practice. In 1231, he decreed that a human body should be dissected at least once every five years to advance anatomical research; attendance would be mandatory for anyone who wanted to practice medicine. 

In the 18th and 19th centuries, it wasn't uncommon for American physicians to acquire research cadavers by unscrupulous means. In 19th-century Baltimore, Johns Hopkins University and other medical schools routinely dispatched students, janitors and doctors to exhume graves.

In 1968, the Uniform Anatomical Gift Act established a regulatory framework for body and organ donation, which required the consent of the deceased. At UVM and medical schools across the country, the dissection of willed human bodies is still a foundational part of medical education — and a rite of passage that, for many students, is by turns enlightening and profoundly weird.

"I don't think it's unnatural for students to have an emotional reaction to human remains," Mawe said. "But we firmly believe that this is the best way to teach anatomy."

Each year, some 200 UVM students use the anatomy lab; most are first-year medical students, who are required to spend a semester learning human anatomy through dissection. On a recent Tuesday afternoon in the lab, on the fourth floor of the Given Medical Building, 12 white, zippered body bags rested on stainless steel dissection tables. A sealed plastic bin at each workstation held the donor's spent remains; once the students conclude their study of a particular donor, UVM returns the cremated remains to the family. A chalkboard at the front of the room offered some tips for handling ("Complex! Delicate!") skulls, along with a gentle reminder of how those skulls got there in the first place: "A human being donated this to us so we could learn." 

Working in groups of four, first-year medical students spend a semester getting acquainted, tissue by tissue, with a single donor, who remains anonymous to them save for a few pertinent facts: age, sex, cause of death and, in certain cases, occupation in life.

When first year-medical students begin their anatomy course, they receive a binder containing messages from the donors about why they chose to give their bodies to the medical school. Molly Hurd, a first-year medical student, remembers fighting back tears the first time she read the testimonials. "The one I really remember was from a nurse, who talked about her journey in health care and how, at the end of her life, she wanted to perpetuate the study of medicine," Hurd said. 

After Tom Lever died, Theresa, his wife, and two of their friends delivered his body to the medical center. To keep him steady in the back of a friend's van, Theresa said, they secured him to a board with bungee cords. Theresa thinks Tom would have approved. "He was such a fix-it guy," she said. "He would have loved knowing that he was bungee-corded."

Afterward, she sometimes wondered what was happening to his body.

"It wasn't disturbing or scary or anything like that," Theresa said. "It was really kind of interesting to me. Obviously, I knew that he was dead, and that it was just his body up there, but there was something kind of alive about the whole experience — like, it wasn't the last chapter yet. I was very glad to know that he was there."

By the time Theresa attended the Convocation of Thanks in the spring, Tom had been dead for more than four years. But the ceremony gave her an opportunity to celebrate his memory in the presence of people whose lives had been changed as a result of his decision to donate his body. A medical student spoke about how his donor restored his self-confidence in the grueling early weeks of medical school, and Theresa shared her own reflections on Tom's cancer diagnosis and death. "It was lovely, really," she said.

For Rich Arentzen, whose friend, Ralph Preston, willed his body to UVM in 2020, the spring ceremony provided a kind of emotional closure, particularly given the pandemic's cancellation of collective, in-person grieving. "I was really awed and honored by the solemnity by which they treated the donors and their families," Arentzen said. "I found it very moving, actually. And that wasn't something I had expected."

Preston, a world-renowned builder of miniature ships in bottles, died at 92 of natural causes. He was physically robust; as Arentzen put it, "someone cutting into his muscles would see something a little unusual for a guy that age."

Preston's desire to donate his body, Arentzen explained, was connected to his own spiritual beliefs, which weren't based in religion so much as his reverence for the relationship between scientific understanding and the vast mystery of the universe. "He thought it a great honor to donate his body to science when he passed," Arentzen said.

In Arentzen's view, there's something radical about entrusting your remains to strangers. "I mean, you are dead, and it's your body, but you're letting yourself be fully exposed and taken apart in an extremely intimate manner," he said.

The anatomy lab is where many students first encounter a dead human body, Mawe said. The experience can be overwhelming, a visceral reminder of the thin line between here and there.

"This was a person who lived a full life, and you begin to think about that life," Mawe said. "Sometimes, they're reminded of a loved one who died recently."

On rare occasions, students have fainted in the lab. ("We used to keep some orange juice around," Mawe said). When Mawe notices a student getting upset during a dissection, he said, he'll invite them to sit in his office, just down the hall, and remind them that the donor made a conscious choice to be there. 

Chris Pham, a 24-year-old first-year UVM medical student from Seattle, said the idea of working on a cadaver initially struck him as a bit medieval. "One of my first thoughts going into the experience was, like, Why are we still doing this? Technology and medical education has advanced a lot, and there are virtual dissectors out there that are pretty sophisticated now," he said.

In fact, anatomy students used a 3D virtual dissection program in the early days of the pandemic, when UVM suspended in-person classes, Mawe said. But in his view, the simulations can't re-create the tactile experience of working on a real body, which prepares students for the many variations of the human habitus they will encounter as physicians. 

Pham, now almost three months into his anatomy course, said he's come to see his experience in the lab as valuable training not only in the mechanics of the body, but in the emotional and psychological demands of his chosen field.

"You're confronted very early on with the reality of what you're going to be doing as a physician: treating a human body and seeing each patient as an individual," he said.

And in some ineffable sense, he added, he views this part of the learning process as the fulfillment of a spiritual obligation to the donors: "I think it's one of the highest forms of respect to the person, based on the intent that they had in giving their body in the first place, to actually go through and learn the human body with their gift, to make the best of their gift."

This learning process hasn't been without its uncanny moments, and certain parts of the body, Pham noted, tend to elicit strong reactions. For Pham, the hands of his donor have been a particularly potent reminder of his own grandmother, who died a year and a half ago. Pham was at her bedside, holding her hand.

"The hands are the literal, physical extensions of the mental entity that occupies the body," Pham said. "Then you touch a hand without a being behind it, and that nothingness is so strange." In the instant after his grandmother passed, Pham said, he had a vivid recollection of a photograph of his grandmother holding him as an infant. "It was as if she was saying to me, 'I've been here since the beginning, and I'll continue to be with you,'" he said.

As Pham progresses in his training in the anatomy lab, he wants to hold on to his capacity to feel deeply, to stay in touch with his own humanity as a way of honoring the donor.

"The responsibility I've put on myself is to remember, always, that this is a human body," he said. "Like, don't disassociate from that. Don't try to mute the gravity of that."